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| STUDENT'S NAME: |
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| STUDENT
DUX NO: |
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| YEAR LEVEL: |
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| SCHOOL: |
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| PRINCIPAL: |
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| EMAIL: |
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| CLASS TEACHER/COORDINATOR: |
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| Behaviour
Education CONSULTANT: |
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| DATE: |
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| INITIAL
FUNDING |
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| HAS
BEEN FUNDED IN PREVIOUS YEAR(S) |
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| PARENT/GUARDIAN SUPPORT OF APPLICATION |
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IS
THIS STUDENT OF ABORIGINAL OR TORRES STRAIT ISLANDER ORIGIN?
For persons of both Aboriginal & Torres Strait Islander origin, mark
both ‘yes’ boxes.
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No |
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Yes, Aboriginal |
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Yes, Torres Strait
Islander |
| SPECIAL
EDUCATION TARGETTED STUDENT |
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| This application has been discussed with a member of the Behaviour
Education Team and authorisation for this funding application has been given by
the Principal: |
Yes |
No |
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| Comments/History
of student's behaviour, include incidents of suspension |
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| Behavioural
& Educational Needs |
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| Positive
Intervention Strategies used by School to meet Student's needs |
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External
Professional Intervention/Agencies
involved in supporting student.
Eg. Counsellors, Social Workers, Therapists, Psychologists, Special
Education, CAMHS |
Documentation
Available
Eg. Psychology Report |
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| Describe
the Project/Initiative Strategy |
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| Short
Term Objectives |
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| Resources/Funding
Required (ie TRT, ESO hours, other expenses) |
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Total
Amount Requested |
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